Signs and symptoms

of a traumatic brain injury

SIGNS AND SYMPTOMS of BRAIN INJURY

The CDC estimates that at least 5.3 million Americans currently have long-term or lifelong need for help to perform activities of daily living as a result of a traumatic brain injury. (1) The signs and symptoms of a (traumatic) brain injury (TBI) can be subtle. Symptoms of a TBI may not appear until days or weeks following the injury or may even be missed as people may look fine even though they may act or feel differently. The following are some common signs and symptoms of a Brain Injury(2):

 Headaches or neck pain that do not go away;

• Difficulty remembering, concentrating, or making decisions;
• Slowness in thinking, speaking, acting, or reading;
• Getting lost or easily confused;
• Feeling tired all of the time, having no energy or motivation;
• Mood changes (feeling sad or angry for no reason);
• Urge to vomit (nausea);
• Increased sensitivity to lights, sounds, or distractions;
• Blurred vision or eyes that tire easily;
• Loss of sense of smell or taste;
• Ringing in the ears.

TBI can cause a wide range of functional changes affecting thinking, sensation, language, or emotions.

• Thinking (i.e., memory and reasoning);
• Sensation (i.e., touch, taste, and smell);
• Language (i.e., communication, expression, and understanding);
• Emotion (i.e., depression, anxiety, personality changes, aggression,
  acting out, and social inappropriateness).
  

TBI can also cause epilepsy and increase the risk for conditions such as Alzheimer’s disease, Parkinson’s disease, and other brain disorders that become more prevalent with age.

 FIRST AID FOR SEIZURES

airway clear)

• Don't use artificial respiration unless
  
• breathing is absent after muscle jerks subside, or unless water has been inhaled.
• If the seizures lasts more than five to seven minutes or if a second seizure starts soon after, call for EMS

GREY MATTER, GREY

ISSUES

Recording Seizures for your Doctor

Part of the issues with Brain Injury are recognizing seizures and conveying this to your neurologist. The predisposition, especially in early awareness and treatment is frequently to assume that the events described are not seizures, so the accuracy of your diagnosis depends on the doctor having a clear picture of what transpired.

Keeping a seizure record (even for events that you cannot say without a shadow of a doubt are seizures), with details (while still fresh) will give the neurologist a clearer picture of the event. Friends, relatives, caregivers, etc, can describe the seizure and the events surrounding it will aid in the diagnosis. It will also give you a sense of what is happening. There may be several stages in a seizure and each stage should be recorded.

Warning indicators and build-up

This may be a brief (30 second) aura, or may last several days. In some instances an "aura" (a simple partial seizure) consisting of odd sensations such as hallucinations (hearing music or voices, or seeing shapes), an unpleasant smell or taste, tingling feeling or "butterflies" in the stomach, or visual distortion may act as a brief warning that a major convulsive seizure is likely to follow. It might also be a build of emotional changes (irritability, etc) for a day or two prior to the tonic-clonic (grand mal) seizure. Recognizing the warning indicators will allow you as well as your caregivers to better prepare for the event.

The seizure
This may be one of many types.  Each seizure affects a person’s level of awareness and consciousness in different ways.

After the seizure
Recovery may take only a few moments or several hours.  On rare occasions effects may last as long as a few days. This is known as the postictal state.  After major convulsions, there is often confusion, drowsiness, unsteady gait, headaches and speech issue (aphasia).  In other instances, the tonic-clonic seizure is followed by complex partial seizures, disorientation, behavioral changes, memory lapses and wandering may occur.  These affects need to be recorded as well.

In some people, especially those with brain injuries, more than one type of seizure may occur.

Date and time stamp the event:
Record the date and time of the seizure and how long it lasted.

Describe what was happening before the event began.

Was the person ill, upset, anxious? Was he or she asleep at the time? What did the person do that got your attention (cry out, make a statement, stare, act fearful, etc)?

Describe the event
Did the person stare blankly? Become stiff or limp?  Was the speech affected (if so, how - slurred, mixed up, etc)?  Did his or her body jerk, twitch or go into convulsions?  Was his or her breathing affected?  Did he or she become incontinent?  Were there any injuries as a result of the event?  Was the person unconscious (even if the person appeared to be awake, and mobil?).

Describe what happened after the seizure
Was the person alert, confused, sleepy, irritable, etc.   How long did the recovery period last (including any sleep)?   Finally, describe anything you may associate with the event such as lack of sleep, drinking alcohol, street drugs, stress, over exertion, etc).

A complete account such as this can be very useful, especially at the onset of care, when the diagnosis is still being considered,  or at times of change (e.g. changes in medication, or a change in the pattern of seizures).  After the clear picture of the patterns have been established, a simple record of the seizure, the duration and the pattern is needed.

1. Thurman D, Alverson C, Dunn K, Guerrero J, Sniezek J. Traumatic brain injury inthe United States: a public health perspective. Journal of Head TraumaRehabilitation 1999;14(6):602–15

2. Centers for Disease Control and Prevention (CDC), Facts about
concussion and brain injury, 1999

3. National Institute of Neurological Disorders and Stroke. Traumatic brain injury:  hope through research. Bethesda (MD): National Institutes of Health; 2002 Feb.  NIH Publication No.: 02-158